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The temporomandibular joints or TMJs are two joints sitting in front of the ear and in the area of the lateral upper cheek. These are joints that together open and close the jaw and help in chewing and talking. It is a ball in socket type joint with the ball being on the mandible and the socket being on the face.
The syndrome of TMJ disease is a common cause of facial pain. The most common name for the disorder is TMJ disorder, according to specialists. TMJ disorder can be related to the muscles and secondary to myofascial pain in the face. It can also be due to joint problems directly within the joint itself. Many patients have both conditions going on at the same time. If the muscles are purely affected, the problem is usually due to bruxism or daytime clenching of the jaw. If the joint itself is purely affected, it is usually caused by degenerative joint disorders, recurrent dislocations of the joint, disc displacement problems, systemic arthritis, infections, cancer and ankylosis.
TMJ disorder is very common. Up to 75 percent of all people in the US will have the signs and symptoms of TMJ disease. About 5-10 percent of people will completely fulfill the diagnostic criteria to have the diagnosis of TMJ disease. It is most common in Caucasians than in other races and is more common in women with a ratio of female to male of one to four. Younger women and men, ages 20-40, are at greater risk for the disease.
Doctors can diagnose TMJ disorder with a complete history and physical examinations. Doctors ask about heavy computer use, psychiatric problems, facial trauma, poor tooth care, eating disorders, neck or shoulder pain, teeth clenching or grinding, pain in the TMJ, clicking, snapping or popping of the facial area, limited jaw opening or locking episodes of the jaw, and headaches related to TMJ.
The physical examination can show forward head posture, malocclusion, clenching of the teeth, range of motion of the jaw which is abnormal, a sore TMJ area and spasm of the muscles around the TMJ.
The causes of TMJ, as mentioned, are muscular or joint in origin. There can be multifactorial causes that together mean you have TMJ. Disc displacement is the most common cause of joint related TMJ disease. Doctors can do a CBC if an infection is suspected and can do an erythrocyte sedimentation rate, a rheumatoid factor or a FANA as a way of identifying generalized joint disorders. An arthrocentesis or needle "biopsy" of the joint can identify crystals of gout or pseudogout in the joint space.
A plain x-ray can be done to show degeneration of the joint. A CT scan of the head and face can show abnormalities of the joint, as can an MRI of the face. The MRI is considered the best test for TMJ disease. There are tests of occlusal strain can use photoplastic phenomena of some polymers.
Treatment of TMJ is not completely required as many cases are self limited and go away on their own. If the disease is not easily treatable with conservative measures, then surgery is required. The treatment can be difficult and complicated and can involve a team of healthcare practitioners, including a psychologist, a physical therapist, an ENT specialist, and a dentist. Pharmacology might be required to treat the disease. Medications include the use of nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen. It also includes certain tricyclic antidepressants in low doses that seem to treat pain and stress. You can use Flexeril for muscle spasm and certain benzodiazepines, which relax the muscle. Botulinum toxin can relax and paralyze the affected muscles, leading to a lesser amount of tension on the muscles.
Occlusal splints or "night guards" can reposition the bite so that there is less tension on the joint. There are anterior repositioning splints and splints known as "auto-repositional" splints. There is pain relief when using the splint that may only be needed at night while sleeping. Auto-repositional splints are also called muscle splints that relieve pain in up to 90 percent of patients. Some splints need to be worn all day and night long.
Surgical management of TMJ disorder is not easy and may be appropriate if no other treatment is effective. Arthroscopic surgery can correct some problems using a small scope that goes into the joint and can take care of some internal derangements of the joint, adhesions of the joint, fibrosis and degenerative changes in the joint. Open surgery can replace the joint itself with an artificial joint.
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